An international study into kidney cancer recurrence has found that doctors can predict the likelihood of a patient’s disease returning by examining DNA mutations in their tumours.
The study was completed by a team of 44 researchers from 23 institutions across Europe and Canada. The study titled ‘Application of genomic sequencing to refine patient stratification for adjuvant therapy in renal cell carcinoma’ is the largest on the genetic changes that cause kidney cancer recurrence.
Over 400,000 people are diagnosed with kidney cancer each year globally, 13,000 of which are in the UK. The researchers hope their findings will contribute to developing more personalised treatment approaches for kidney cancer.
Cancer treatment needs to be more specific
“Development of new treatment for kidney cancer has lagged behind other cancers, and we largely continue to adopt a ‘one size fits all’ approach,” said co-lead investigator Dr Naveen Vasudev from the Leeds Institute of Medical Research at St James’s.
“Accurately determining the risk of recurrence is very important. As well as helping us identify how often patients need to be seen by their doctors, it helps us to decide whom to treat with immunotherapy. This treatment has recently been shown to reduce the chances of cancer coming back but can cause side effects. The danger currently is that some patients may be over-treated, so being able to better identify patients at low risk of recurrence is important since they could be spared more treatment,” continued Dr Vasudev.
The researchers analysed changes in the DNA of over 900 kidney cancer samples before creating four sub-groups based on the mutations in 12 specific genes within the DNA of each patient. The team also examined whether cancer had recurred in these patients.
They found that 91% of patients in one mutation group remained disease-free five years after surgery, meaning they could potentially avoid unnecessary treatment. Meanwhile, the percentage of patients in a different mutation group who remained disease-free at five years was significantly lower, at just 51%. These patients were deemed to require more aggressive surgery.
Preventing kidney cancer recurrence
Doctors currently assess the risk of kidney cancer recurrence by examining features like the size of the tumour and how aggressive it appears under a microscope. Up to 30% of localised kidney cancers return after surgery, meaning more accurate methods of assessing this risk are needed so that patients who do not need further treatment can be identified.
The study has shown that genetics can be used to better predict the likelihood of kidney cancer recurrence. DNA sequencing is already available through the NHS for several other cancers.
“Genomics – the study of genes and how they interact with each other – is a key area of development in patient care for the NHS. Here we show how genomics might be applied to patients with kidney cancer, potentially creating more personalised treatment options for thousands of patients each year,” said Dr Vasudev.
“Our research shows that it may be possible to improve the way we determine risk in each patient by looking at the genetic mutations present in their cancer. DNA sequencing is already being used to help patients with other types of cancer and so could be readily applied to patients with kidney cancer,” concluded co-lead investigator Dr Yasser Riazalhosseini, assistant professor of Human Genetics at McGill University.
